By the end of this session participants will have:

• Understood what might help men engage with services and what
might act as a barrier.
• Considered the importance of understanding, empathy and
person-centred approaches in the service they provide.
• Considered what they and their service need to attend to, to
ensure men engage and sustain a relationship with services.
Visiting the clinic: a starting point
In preparation for the Masterclass you were asked to consider a
number of areas regarding work with gay, bisexual and MSM:
•My professional experience to date.
•My confidence.
•My skills.
•My knowledge of gay/bi/MSM sexual behaviour.
•My familiarity with the language I need.
•My understanding of discrimination or stigma.
•My level of comfort.
•My interest in working with gay/bi/MSM.
Discussion
With a partner take a few minutes to chat about one area where you
feel strong/confident, and one area where you feel that you need some
support to improve your practice. Share something of why you feel the
way you do. You will not be asked for feedback in the larger group.
In the next few slides we hear from men about their experiences of
visiting their local clinic. The contributions are taken from the FAQ
community engagement aspect of the HIV Needs Assessment.
A positive view and experience of services
It was absolutely perfect but the thing is to actually go, it wasn't easy
for me. But once I was there, amazing. The nurse at the clinic was
really
nice, explained it was confidential and she tested me for everything.
(Bisexual, 16-25, HIV negative)
I think there were issues in the past but I think now they don't have
problems. I think they've opened their eyes to reality. It used to be like
gay men didn't exist... I have sort of a rapport with her now. I trust her
judgement and she's professional about what she does.
(Gay, 45+, HIV negative)
I just find the service wonderful. I've been tested there and I know the
people but I value most the service itself. They're very professional and
very helpful. Do you think most guys would understand what they are
told by the nurse or doctor? Most guys would understand it. It wasn't
difficult language. It was friendly even though you were talking to a
doctor. Nice smile. I think most guys would act on it… It's one of those
things where you are dealing with somebody in front of you. You have
to force yourself to spit it out. I felt comfortable but it was not a
comfortable issue.
(Gay, 26-35, HIV negative)

Discussion
Do the comments, on this and the previous slide reflect the
experience of men using your service? How do you know?
Men also talked about services that provided a less positive experience.
This might be thought of as a ‘tick-box’ experience, with set questions
rather than a conversation or lacking a focus on the individual’s experience
and needs.
What sort of things did you talk about? Don't talk, just get the test and that
was it, no conversation… They asked me questions about what contact, what
sex I had, but basic. I just tell them I've used condoms, for the most part I do.
But you had said previously you don't always? Yes, but they say use condoms
for things like oral and that would be crazy so you just say the same things.
(Gay, 16-25, HIV negative)
There was some discussion, form filling, questions, very impersonal, not so
open. No discussion about sex I like, just a checklist… You seem to be
objected to a particular doctor's manner, so it wasn't a space to talk about
my sexuality. It was about 'have you done various things'. Very fixed view of
gay male sexuality. (Gay, 36-45, HIV negative)
They ask questions about what you do, but not really a discussion.
(Gay, 16-25, HIV negative)

How comfortable are you speaking to someone at the clinic?

Depends on who you get and which day you go. It depends if you
get a bubbly, chirpy doctor who wants to make you feel comfortable
or someone who just wants to stick a needle in your arm and take your
blood. I've been in when they tell me there are too many people to see.
(Gay, 26-35, HIV negative)

Discussion
Taking the role of critical friend to your own service, do these comments
(reflecting what we have termed a ‘tick-box experience’) reflect your
service in any way?
Visiting the clinic: a negative experience?
A minority of men have also talked about negative experiences when
attending a sexual health or HIV service.
It is more just they give you a lecture even though you’re in a relationship
because they say you're still at risk. I do think looking at my background
you can't influence people with a big stern lecture. You make people
despondent I think. I think education is one thing and ramming it down
ones throat isn't useful.
(Gay, 36-45, HIV negative)
I was with my partner and he was nervous so I asked the receptionist
if I could go in with him and she said go away and be quiet. It’s not as
friendly or as welcoming as they should be. I didn't complain, but it’s
about customer service. So anyway, I didn't go in with him.
(Gay, 36-45, HIV negative)
One nurse was very harsh. She thought I was just rolling up to get tested,
and she gave me quite a harsh perspective so I said 'Listen love, I know
about HIV' and I did speak to one of her colleagues about her attitude.
What if I'd been someone who had no knowledge whatsoever about
HIV and she spoke to me in that tone, really heavy? I spoke to the
receptionist and told her that I just felt like her tone wasn't really nice
and she was really sympathetic and said she would pass that on. I
didn't want to get anyone in trouble but I didn't want to leave it at that
I felt unsatisfied about her tone. It was quite judgemental. (Gay, 16-25,
HIV negative)

Discussion
Do you think these comments might reflect the experience of men using
your service in any way?
How is my service experienced?
1. A negative experience: A service that men experience as
unsympathetic or lecturing.

2.

3. A service that may be trying hard but men may have a ‘tick-box’
experience.

4.

5. A positive experience: A service that men find is informed,

empathic, comfortable, person-centred.
Discussion
What might act as barrier to gay, bisexual or MSM engaging with
sexual health services or make them feel that the experience is not
always positive ?
1.
2.
3.
What might facilitate their engagement or make men feel that
engagement is a positive experience?
1.
2.
3.
Visiting the clinic: barriers and facilitators identified by men contributing
to the HIV Prevention Needs Assessment
Barriers:
•Lack of anonymity: Clinics which are not discreet, overcrowded and
where other people might know you.
•Unapproachable, judgemental or rude staff.
•Fear of positive results.
•Inaccessible location.
•Waiting times at drop-in/walk-in clinics.
•Feelings of embarrassment or shame.
•Poor or restricted opening hours/difficult to access or restricted
appointment slots.
Visiting the clinic: barriers and facilitators identified by men
Facilitators:
•Easy accessibility: times suit or they are near where you live.
•Confidential and discreet services.
•Qualities and skills of clinic staff: friendly and non-judgemental.
•Services that offer rapid testing and results.
•Clinics with flexible, evening or weekend opening.
•Clinics where there is little or minimal waiting.
•Clinics which offer good support and advice.
Men have identified the importance of understanding, empathy and
being person-centred:
I think they would need to have some understanding of the breadth of
the gay sexual experience. Thinking about that, I suppose heterosexual
sex is also a broad experience isn't it. Something gay guys do, I find
distasteful, but if I were caring for someone I would want to watch my
nonverbal communication the way I react to something I didn't like the
thought of.
(Gay, 45+, HIV positive)
Sincerity is the main thing. Any doctor I've encountered who made
the process easier it is because they are the type of people they are.
(Bisexual, 45+, HIV negative)
Advice for staff
Don't judge. Be knowledgeable. Offer advice but listen is the most
important one. Don't just assume.
(Gay, 16-25, HIV negative)
I suppose just being patient and listening.
(Bisexual, 45+, HIV negative)
Be more human, less robotic, less work conscious. Not to be a friend like,
but down to our level kind of thing.
(Gay, 16-25, HIV negative)
Smile. Be non-judgemental. Be open about sex and sexual acts, talking
about anal sex and you know, gay sexual practices. Be sort of friendly. Be
non-authoritarian and non-disapproving.
(Gay, 45+, HIV positive)
Just seem interested I suppose and take time to explain. Just be trained for
counselling and be professional.
(Gay, 26-35, HIV negative)
They would need to know the full facts of anyone's case. Their situation, so
they could pose the relative questions and enter the discussion with that
person, then it would become more personal.
(Gay, 45+, HIV negative)

Discussion
How do you feel about these expectations of you as a professional
and the service you provide?
If we are to think about service improvement, what needs to be done to
help improve the experience men have?
Please take a moment to note down
some thoughts on the reflection sheet.
Further information

HIV Prevention Needs Assessment (NHS Lothian and NHS GGC)

www.scotland.gov.uk/Topics/Health/Services/Sexual-Health/HIVMSMNee
ds

FAQ Scotland Chapter 19 Visiting the Clinic at www.faqscotland.co.uk